Laparoscopic peritoneal entry with the reusable threaded visual cannula.

STUDY

OBJECTIVE

To estimate the feasibility, reproducibility, and safety of laparoscopic port establishment using a trocarless and externally threaded visual cannula (TVC).

DESIGN

Multicentre, prospective, observational study (Canadian Task Force classification II-2).

SETTING

Three university-affiliated teaching hospitals.

PATIENTS: Four thousand seven hundred twenty-four women (median age, 34 years; median body mass index, 25) underwent laparoscopic surgery.

INTERVENTION: After administration of general anesthesia, the Veress needle was inserted at the umbilicus or the left upper quadrant (LUQ) using Veress intraperitoneal pressure of 10 mm Hg or less as proxy for correct placement. Transient high intraperitoneal pressure of 20 to 30 mm Hg was attained, and primary and ancillary ports were established using the reusable trocarless TVC.

MEASUREMENTS AND MAIN

RESULTS

Institutional research ethics board approval and patient consent for video capture were obtained. Primary umbilical entry was established in 4598 patients (97.33%), primary LUQ entry in 123 (2.60%), and primary suprapubic entry in 3 (0.06%) patients. Peritoneal preinsufflation was abandoned when 3 consecutive umbilical or LUQ Veress needle insertion attempts failed. Some patients at high risk with known peritoneal adhesions or previous lower abdominal midline scars did not undergo preinsufflation, and the trocarless TVC was applied directly. Surgery was postponed in 3 patients in whom insufflation failed, to enable further counseling and appropriate consenting. There were no serious abdominal wall or intraabdominal vascular injuries. One transverse colon, densely adhered to the umbilical region, was injured, which was recognized and repaired intraoperatively. Residents, fellows, or faculty recorded entry-related data on forms postoperatively for study and analysis.

CONCLUSIONS

Establishing peritoneal ports with the trocarless TVC is feasible, reproducible, and seems to be highly adoptable.